Pathophysiology and prevention of type 2 diabetes

A number of new findings in the pathophysiology and prevention of type 2 diabetes have been presented in the Diabetes Update over the past 3 years. In this review article, these results are summarized. In addition to the classical insulin-resistance hypothesis, it is discussed whether hyperinsulinemia induced by nutritional factors is causally involved in the development of insulin resistance. Furthermore, there is evidence that inflammatory or stress-related processes play a major pathophysiological role in type 2 diabetes. In addition, pathogenetic changes in the small intestine that are related to the development of type 2 diabetes have been reported. In the field of lifestyle-intervention studies, the Da Qing Diabetes Prevention Study was able to show for the first time that life expectancy can be prolonged by weight loss and increased physical activity. The results of the PREDIMED study show that a Mediterranean diet rich in vegetable fat is able to reduce in addition to total and cardiovascular mortality the development of type 2 diabetes. In a separate trial, a fat-rich diet substantially reduced the need of pharmacological antidiabetic treatment in patients with recently diagnosed type 2 diabetes. These results raise considerable doubts about the current nutritional guidelines regarding a carbohydrate-rich and fat-reduced diet for persons with type 2 diabetes.